About the service:

•Pine House is registered to provide accommodation and personal care support for up to three people who have a learning disability and may have autism or display characteristics that fall within the autistic spectrum disorder.

•Pine House is a terraced house and accommodation is provided over two floors. The ground floor communal areas comprise of a kitchen and dining room, and a sitting room. All rooms are of single occupancy. One bedroom has en-suite facilities. There were deliberately no identifying signs, intercom, cameras or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

•The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

•At the time of our inspection, three people were living at the service.

People’s experience of using this service:

•People and relatives told us the service was safe and well led, and staff provided an effective, caring and responsive service.

•People were safeguarded from the risk of harm and abuse.

•People received safe care from staff who were knowledgeable about the risks and how to manage them safely.

•People’s needs were safely met by sufficient and suitable staff.

•People’s medicines needs were met safely by staff who were well trained and skilled.

•The service was clean. Staff safeguarded people from the risk of infection.

•Staff told us they felt well supported and they received regular supervision.

•People told us their individual needs were met by staff who knew their likes and dislikes.

•People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

•People's care plans were person-centred. Staff knew how to provide personalised care.

•Staff treated people with dignity and respected their privacy. People and relatives were involved in the care planning process and their independence was encouraged.

•People and relatives knew how to raise concerns and they told us the service was responsive.

•People, staff and healthcare professionals told us they the service was well led. They told us that they found the registered manager approachable.

•The provider worked collaboratively with other organisations to improve care.

•The provider had effective systems and processes in place to ensure the quality and safety of service.

Rating at last inspection:

•Good (report published 10 September 2016).

Why we inspected:

• This was a planned inspection to check that this service remained Good.

Follow up:

•We will continue to monitor intelligence we receive about the service until we return to visit as per our reinspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection visit took place on the 27 June 2016 and was unannounced.

Pine House is a service of Connifers Care Limited. It is a residential care home registered to provide accommodation and personal care for up to three people who have learning disabilities or autistic spectrum disorder.

Prior to this inspection the service was last inspected on the 28 April 2015 and was found overall to require improvement and had four breaches of the regulations Breaches related to the service not consistently working to the principles of the Mental Capacity Act 2005 (MCA). Medicines administration systems were not always followed by staff, in particular when administering as and when required medicines to help manage people’s behaviour. In addition systems of managing infection control were not effective and some aspects of safe management of the environment were compromised.

We checked these areas at this inspection and found that consent was requested from people and that medicines administration was safe. The service had effective infection control measures and environmental checks were undertaken.

There was no registered manager at this service at time of this inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The Director had undertaken the role of acting manager whilst supporting an experienced team leader who was in the process of applying to be the registered manager of the service.

We found that the service had adequate staff to meet the needs of the people using the service and there were safe recruitment processes in place.

The service had risk assessments to keep people and the environment safe. There were clear guidelines for staff to follow.

The service had provided supervision and trained staff to equip them to undertake their roles. Staff told us they were well supported by the acting manager and team leader.

The service was meeting people’s health and nutritional needs and supported people to access appropriate health services.

The staff were caring in their support of people. People and their families were involved in care planning and reviews but the care plans were not always signed to reflect this. We brought this to the attention of the acting manager who agreed to ensure this took place.

People undertook a variety of activities and were supported to have a routine that was meaningful to them.

There was a complaints policy and procedure displayed and a complaints book was placed in a communal area to assist people to complain.

The service was well-led, the director was acting manager and an experienced team leader was in the process of applying to be the registered manager.

Regular audits were undertaken to ensure the quality of the service, and the service worked in partnership with other agencies.

During our visit we were able to speak with one person who used this service. We were able to communicate with one other via non-verbal means. We saw that people were treated with respect and dignity. We saw that staff interaction with people was appropriate and professional.

We looked at care plans for three people and saw that the provider had used information from associated professionals such as social workers and that people and their representatives had been asked their opinion. People who used this service had good contact with appropriate professionals and the provider operated an effective referral system.

People told us that they felt safe using the service. Staff training records confirmed that staff had all completed training in safeguarding and knew how to escalate any concern.

Staff had completed a robust induction programme and selection process. This ensured that the centre was effectively staffed by appropriately trained people.

Records that we read showed us that the provider was continually striving to review and improve the service.

When we arrived at Pine House we found there were 3 people who used this service at home and four staff on duty. People who lived at this home all had communication difficulties and complex behaviours but through observing their care and with support of the staff we were able to see that people were treated with dignity and respect. Care plans and other documentation that we read told us that people were fully involved in decision making in all areas of their daily living. Care plans also showed us that people had their individual needs met and had good access to health care professionals such as doctors, district nurses, dentists and social workers.

People who use the service indicated to us that they felt safe at the home. They told us they had no concerns about their care.

Staff that we spoke to told us that they had an appropriate induction. They also said that training opportunities for both their day to day work and vocational needs were encouraged and regularly provided.

Policies and procedures and health and safety files that we read told us that the provider offered an effective and safe service.

There were three people living in the home at the time of our inspection. We spoke to one person. He said, “I like it here. It is very nice. The staff are not too bad”. During our visit the atmosphere of the home was calm and we observed good interaction between staff and the residents.

This unannounced inspection took place on 28 April 2015. Our previous inspection, of 29 November 2013, found there to be no breaches of regulations.

Pine House is a residential care home for up to three people. The service’s stated specialism is people who have learning disabilities. There were no vacancies at the time of our visit.

At the time of our visit, there was a registered manager in place at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that Pine House had a supportive atmosphere. Staff understood people’s different ways of communicating, and people’s choices were listened to. There was a range of positive feedback about the service, and we saw evidence of how the service was effective at promoting people’s well-being and reducing instances of behaviours that challenged the service.

Staff underwent a robust procedure to check they were appropriate to work with people before they started work. Staff received good support to deliver care to people appropriately, including through regular training, supervision, and checks of competence. The service had enough staff to support people.

The service attended to people’s individual needs. For example, people regularly attended community activities of their choice. One person had been supported to lose weight through effective attendance at exercise classes. Another person had been supported to better attend to their appearance and personal hygiene.

The registered manager knew the service and people using it well, and was accessible to anyone at the service. There were systems of auditing quality at the service, and we could see that action was taken to address identified shortfalls.

The service took appropriate action if they believed a person needed to be deprived of their liberty for their own safety. However, further work was needed with ensuring that the principles of the Mental Capacity Act 2005 were consistently applied for everyone using the service.

Whilst there were systems of supporting people with their medicines, these were not consistently followed, particularly where people were provided with as-needed medicines in respect of behaviours of theirs that challenged the service. We also found that the recording and reviewing of such incidents was inconsistent. This undermined the safe care and support of people.

Whilst the service placed emphasis on the maintenance of good health, we found that people were not always supported to access healthcare services.

We also found that systems of infection control and hygiene management were not consistently safe, and that a few aspects of safe management of the premises were compromised.

In summary, we found breaches of four of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.